S216 Journal of Cranio-Maxillofacial Surgery 36(2008) Suppl. 1 Abstracts, EACMFS XIX Congress P.192 Impacted third molar extraction: methylprednisolone or nimesulide C. Montosi, A. Murri, P. Bellini, D. Travaglini, L. Giannetti. University of Modena and Reggio Emilia, Modena, Italy Objectives: The aim of this study was to evaluate the effect of two different drugs (methylprednisolone and nimesulide) to de- crease the swelling, pain and trismus after the surgical extraction of mandibular impacted third molars. Methods: This randomized clinical trial comprised thirty (30) adult patients of both genders (15 male and 15 female) with no local or systemic problems, with bilateral impacted lower third molars in similar position (Pell and Gregory’s class IIB), where surgical extraction had been indicated. These patients were separated in two groups at random: the methylprednisolone group and the nimesulide group. A record card was filled in with preoperative and postoperative epidemiological and clinic data about inflammation, pain and trismus. The choice of which side to operate first was made randomly and double-blindly. The swelling was evaluated by ecography. The pain was evaluated by VAS modificated in GRS. The trismus was evaluated by inter- incisal distance. Mean values were compared between the 2 groups with a 2-way analysis of variance and a Student’s t-test or the c 2 test for qualitative comparisons. The threshold of significance was set at 5%. Results: Patients in the nimesulide group showed a more severe swelling (p = 4.2175E-06) and a more severe trismus (p = 0.00034); pain was very similar in both groups. Conclusions: The results confirm the efficacy of methylpred- nisolone in providing a more comfortable postoperative course after surgical extraction of impacted lower third molars. It was more effective than nimesulide to reduce the degree of swelling and trismus. However, it had no clear effect on pain control. P.193 Indications for third molar germs removal N. Stadnitzkaya. Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia Objectives: To define the indications for third molar germs removal according to development stage, topography and patho- logical changes associates with third molars eruption. Materials: 3756 patients aged from 6 to 70 years were included in this study. Results: Third molar germs developmental disturbances were revealed in 19.7% of cases. In complicated eruption and impacted teeth inflammatory complications of various degrees occurred in 75%. 25% of third molars were fully impacted. Three fourths of patients had no clinical manifestations while having radiological pathological signs. Asymptomatic course resulted in late patient visit leading to serious complications. Conclusion: Literature review, conducted study and author’s clin- ical experience allowed defining indications to third molar germs removal: (1) structural and topographic disturbances, increased germ size (1.5-2-fold); (2) alveolar arch narrowing or need for teeth distal shift during orthodontic treatment; (3) need for stabilization of results obtained during orthodontic treatment; (4) pretreatment before orthognatic surgery. Optimal patient’s age for third molar germs removal is 13-16 years, because the growth of mandible distal regions is over and there is no hope for spontaneous eruption of third molars anymore. However, while making the decision in every single case dentist should take into consideration personal peculiarities of facial bones growth and development. P.194 Inferior dental nerve injury and root canal treatment R. Adamji, L. Cheng, N. Polycarou, J. Makdissi. King’s College London, London, UK Introduction: Root canal treatment for saving lower molar teeth has become an established endodontic treatment. However the proximity of the inferior dental nerve (IDN) to the root apices of lower molar teeth can create difficulties to endodontists. Periapi- cal and panoramic radiography cannot always accurately locate the inferior dental canal (IDC) due to 2-dimensional limitation. We report a case of IDN injury after endodontic treatment to a second mandibular molar tooth. Case report: A 36 year old woman presented with recurrent infection from her root filled lower left second molar tooth, and underwent re-root treatment. After removal of gutta-percha material from the canals she reported persistent numbness of her lower left lip. Conventional radiography suggested an intimate relationship of the IDC and apex of the mesial root. A multi- slice CT scan restricted to the mandible revealed loss of cortical outline of the canal and close proximity of the apex and the filling material to the canal. Localised osteitis was also evident. The tooth was surgically removed under local anaesthetic and the root filling was shown to exit the apex of the roots. The numbness of her lip showed no recovery 9 months after exodontia. Conclusion: Clinical and radiographic suspicion of close proxim- ity of IDC to root apices of lower molar teeth prior to endodontic treatment or periapical surgery warrants the use of advanced imaging using CT scanning to provide precise location of IDC. Possible risk to the IDN can then be discussed as an essential part of obtaining patient informed consent. P.195 Intercommunication of radicular and follicular cysts A. Gashi, J. Ahmedi, F. Perjuci, R. Ademi, Z. Agani, V. Hamiti. Department of Oral Surgery, Dentistry school, University of Prishtina, Republic of Kosova Introduction: A case report presents periapical lesion of the teeth 31, 32 associated with follicular cysts of impacted tooth 33. Aim: The aim of the presented case report is a very rare combined pathology in consulted literature. Materials and Methods: 40 years old patient had a visit in our department as a reason of a swelling in lower jaw, mental region, left side. Intraoral he had full mouth porcelain fused to metal bridge. After history taking, intra and extra oral examination, and R¨ o graphs of suspected region, has been diagnosed a periapical lesion in teeth 31 and 32, and the well-defined radiolucency symmetrically surrounds the crown of the unerupted tooth 33 (follicular cyst) close to mandibullar base. OPG shows a com- munication between to cysts, connected with an intrabone canal. Treatment was of combined form, medication with antibiotics and surgical (extraction of teeth 31 and 32 because there was no supporting bone, removal of periapical lesion and extirpation of follicular cyst together with impacted tooth 33). Hystopathologi- cal findings confirmed initial diagnose. Regular follow-ups were done first, second and third month after surgical treatment, and were assessed bone formation. Definitive oral rehabilitation was done by making a RPD for lower jaw. Conclusion: In literature we can find some possibilities of follicular cyst communication with roots of sorrounding teeth, maxillary sinus or mandibular canal. But this case is specific for a reason of distance between origin of two different lesions.